Marcella L. Woud

Ameliorating intrusive memories of distressing experiences using computerized reappraisal training.

The types of appraisals that follow traumatic experiences have been linked to the emergence of posttraumatic stress disorder (PTSD). Could changing reappraisals following a stressful event reduce the emergence of PTSD symptoms? The present proof-of-principle study examined whether a nonexplicit, systematic computerized training in reappraisal style following a stressful event (a highly distressing film) could reduce intrusive memories of the film, and symptoms associated with posttraumatic distress over the subsequent week. Participants were trained to adopt a generally positive or negative poststressor appraisal style using a series of scripted vignettes after having been exposed to highly distressing film clips. The training targeted self-efficacy beliefs and reappraisals of secondary emotions (emotions in response to the emotional reactions elicited by the film). Successful appraisal induction was verified using novel vignettes and via change scores on the post traumatic cognitions inventory. Compared with those trained negatively, those trained positively reported in a diary fewer intrusive memories of the film during the subsequent week, and lower scores on the Impact of Event Scale (a widely used measure of posttraumatic stress symptoms). Results support the use of computerized, nonexplicit, reappraisal training after a stressful event has occurred and provide a platform for future translational studies with clinical populations that have experienced significant real-world stress or trauma.

Reducing analogue trauma symptoms by computerized reappraisal training - Considering a Cognitive prophylaxis?

Background and objectives Distressing intrusions are a hallmark of posttraumatic stress disorder (PTSD). Dysfunctional appraisal of these symptoms may exacerbate the disorder, and conversely may lead to further intrusive memories. This raises the intriguing possibility that learning to ‘reappraise’ potential symptoms more functionally may protect against such symptoms. Woud, Holmes, Postma, Dalgleish, and Mackintosh (2012) found that ‘reappraisal training’ when delivered after an analogue stressful event reduced later intrusive memories and other posttraumatic symptoms. The present study aimed to investigate whether reappraisal training administered before a stressful event is also beneficial. Methods Participants first received positive or negative reappraisal training (CBM-App training) using a series of scripted vignettes. Subsequently, participants were exposed to a film with traumatic content. Effects of the CBM-App training procedure were assessed via three distinct outcome measures, namely: (a) post-training appraisals of novel ambiguous vignettes, (b) change scores on the Post Traumatic Cognitions Inventory (PTCI), and (c) intrusive symptom diary. Results CBM-App training successfully induced training-congruent appraisal styles. Moreover, those trained positively reported less distress arising from their intrusive memories of the trauma film during the subsequent week than those trained negatively. However, the induced appraisal bias only partly affected PTCI scores. Limitations Participants used their own negative event as a reference for the PTCI assessments. The events may have differed regarding their emotional impact. There was no control group. Conclusions CBM-App training has also some beneficial effects when applied before a stressful event and may serve as a cognitive prophylaxis against trauma-related symptomatology.

Editorial for the Special Issue on Cognitive bias modification techniques: An introduction to a time traveller's tale

At the time of writing (December, 2013), a search for cognitive bias modification (CBM) in SCOPUS yields 113 results. Tellingly, the earliest of the articles found by this rather crude search appear in 2009, clustering around the special issue on CBM in the Journal of Abnormal Psychology that year (Koster et al. 2009). While the term CBM had been used in the literature prior to this, and in fact research into CBM (albeit not always using this exact term) had been steadily gathering momentum since the first studies were published in 2000, there has clearly been an explosion in research on CBM in the years since. What has happened in this period? Over the past 4 years, CBM research has been on an exciting journey, with many twists and turns, ups and downs. This special issue seeks to provide an overview of this journey, and a glimpse of the road-or roads-ahead. But where to begin? The journey did not start in 2009, nor even a decade earlier when the dominant CBM paradigms were first described. To fully make sense of this journey, and all the twists in this travellers’ tale, we must go back further still. Once upon a time ... during the cognitive era of psychology ... researchers embarked on the great adventure of exploring the ‘cognitive landscape’ of emotional pathology ... an extremely challenging landscape.... After a few years, the first landmarks were established: cognitive biases in emotional disorders. But what did they signify? It seemed that such selective information-processing biases were crucial factors in the etiology, maintenance, and relapse of various types of emotional disorders. Hence, many cognitive theories built on this discovery in order to account for emotional pathology (e.g., Beck 1987; Beck and Clark 1997; Clark and Wells 1995; Eysenck 1997; Mathews and MacLeod 2005; Mogg and Bradley 1998; Rapee and Heimberg 1997; Wells and Matthews 1994; Williams et al. 1997). Cognitive biases reflect a general processing advantage for disorder-relevant information. The findings of cognitive-experimental research indicate that emotional disorders are (roughly) characterized by three types of biases, i.e., biases in attention, interpretation, and memory. To illustrate, depressed or anxious individuals are, compared to healthy individuals, more likely to attend to negative cues, interpret ambiguity in a more negative manner, and selectively recall negative information (for a review, see Mathews and MacLeod 2005). According to the assumptions put forward by cognitive theories, the functional relationship between biases and emotional pathology can be described as follows: Biases are accompanied by various dysfunctional cognitions, which in turn activate dysfunctional emotional and behavioral responses. Due to the reinforcing connection between cognitions, emotions, and behavior, a ‘psychopathological downward spiral’ becomes activated in vulnerable individuals, possibly resulting in anxietyor depression-related symptoms. In parallel to the development of measures to assess biases in attention, interpretation, and memory, researchers started to investigate whether it is also possible to modify biased cognitive processes. This work was motivated by the question of the causal nature of these biases: while there were many empirical demonstrations of the association between emotional pathology and cognitive biases, it M. L. Woud (&) Center for the Study and Treatment of Mental Health, Department of Psychology, Ruhr University Bochum, Massenbergstrasse 9-13, 44793 Bochum, Germany e-mail: Marcella.Woud@rub.de

Implicit evaluation bias induced by approach and avoidance

We report a study in which faces with a neutral emotional expression were shown on a computer screen. By means of a joystick, participants pulled half of the faces closer (positive approach movement), and pushed the half away (negative avoidance movement). As a result, an operant evaluative conditioning effect occurred in a subsequent affective priming task: Participants responded more quickly to positive target words if they were preceded by a previously pulled face than a pushed face, and vice versa for negative target words. The effect became stronger the more often the faces had been trained to approach or to avoid. No effect was observed on explicit evaluations of the faces: Pushed faces were rated as sympathetic as pulled ones.

The Validity of Different Measures of Automatic Alcohol Action Tendencies

Previous studies have demonstrated that automatic alcohol action tendencies are related to alcohol consumption and hazardous drinking. These action tendencies are measured with reaction time tasks in which the latency to make an approach response to alcohol pictures is compared with the latency to make an avoidance response. In the literature, 4 different tasks have been used, and these tasks differ on whether alcohol is a relevant (R) or irrelevant (IR) feature for categorization and on whether participants must make a symbolic approach response (stimulus-response compatibility [SRC] tasks) or an overt behavioral response (approach avoidance tasks [AAT]) to the pictures. Previous studies have shown positive correlations between measures of action tendencies and hazardous drinking and weekly alcohol consumption. However, results have been inconsistent and the different measures have not been directly compared with each other. Therefore, it is unclear which task is the best predictor of hazardous drinking and alcohol consumption. In the present study, 80 participants completed all 4 measures of action tendencies (i.e., R-SRC, IR-SRC, R-AAT, and IR-AAT) and measures of alcohol consumption and hazardous drinking. Stepwise regressions showed that the R-SRC and R-AAT were the only significant predictors of hazardous drinking, whereas the R-AAT was the only reliable predictor of alcohol consumption. Our results confirm that drinking behavior is positively correlated with automatic alcohol approach tendencies, but only if alcohol-relatedness is the relevant feature for categorization. Theoretical implications and methodological issues are discussed. (PsycINFO Database Record

Getting into the Spirit: Alcohol-Related Interpretation Bias in Heavy-Drinking Students

Alcohol misuse is characterized by patterns of selective information processing. The present study investigated whether heavy- compared with light-drinking students, show evidence of an alcohol-related interpretation bias to ambiguous, alcohol-related cues. Toward this aim, participants were asked to create continuations for ambiguous, open-ended scenarios that provided either an alcohol-related or neutral context. Results showed that heavy-drinking students generated more alcohol continuations for ambiguous alcohol-related scenarios than light-drinking students. This result was independent of the coding method used, with an interpretation bias found when continuations were coded by either participants themselves or by two independent raters.

Don't panic : interpretation bias is predictive of new onsets of panic disorder

Psychological models of panic disorder postulate that interpretation of ambiguous material as threatening is an important maintaining factor for the disorder. However, demonstrations of whether such a bias predicts onset of panic disorder are missing. In the present study, we used data from the Dresden Prediction Study, in which a epidemiologic sample of young German women was tested at two time points approximately 17 months apart, allowing the study of biased interpretation as a potential risk factor. At time point one, participants completed an Interpretation Questionnaire including two types of ambiguous scenarios: panic-related and general threat-related. Analyses revealed that a panic-related interpretation bias predicted onset of panic disorder, even after controlling for two established risk factors: anxiety sensitivity and fear of bodily sensations. This is the first prospective study demonstrating the incremental validity of interpretation bias as a predictor of panic disorder onset.

Make the manikin move: Symbolic approach–avoidance responses affect implicit and explicit face evaluations

The present research aimed to replicate and extend findings of Huijding, Muris, Lester, Field, and Joosse (2011), investigating whether symbolic approach–avoidance responses can induce implicit and explicit evaluation biases. Faces with a neutral expression were shown on a computer screen, and participants were instructed to repeatedly move a manikin towards some faces (approach) and away from other faces (avoidance). An affective priming task and a face rating task were used to assess training-compatible differences in implicit and explicit face evaluations, respectively. Results showed that the manikin training was successful: The priming task revealed more positive implicit evaluations of approached than avoided faces, and approached faces were rated more positively than avoided ones in the face rating task. These findings replicate those of Huijding and colleagues by demonstrating training effects on explicit evaluations, and they extend them by demonstrating effects on implicit evaluations.

Tell me why... The influence of self-involvement on short term smoking behaviour.

Previous studies found that information is more persuasive when self-generated (high self-involvement), rather than when simply read or heard (low self-involvement). In two studies, we investigated whether differences in self-involvement concerning smoking issues would influence immediate smoking behaviour. As predicted, results indicate that participants who developed their own arguments against smoking waited longer before lighting up a cigarette than those who read arguments against smoking that were developed by other participants (Study 1). Further, participants who additionally generated their own arguments were less likely to smoke within 30 min than those who read prepared arguments against smoking (Study 2). In sum, our studies illustrate that personal involvement in generating anti-smoking arguments can reduce short term smoking behaviour.

Modification of cognitive biases related to posttraumatic stress: A systematic review and research agenda

Cognitive models of Posttraumatic Stress Disorder (PTSD) postulate that cognitive biases in attention, interpretation, and memory represent key factors involved in the onset and maintenance of PTSD. Developments in experimental research demonstrate that it may be possible to manipulate such biases by means of Cognitive Bias Modification (CBM). In the present paper, we summarize studies assessing cognitive biases in posttraumatic stress to serve as a theoretical and methodological background. However, our main aim was to provide an overview of the scientific literature on CBM in (analogue) posttraumatic stress. Results of our systematic literature review showed that most CBM studies targeted attentional and interpretation biases (attention: five studies; interpretation: three studies), and one study modified memory biases. Overall, results showed that CBM can indeed modify cognitive biases and affect (analog) trauma symptoms in a training congruent manner. Interpretation bias procedures seemed effective in analog samples, and memory bias training proved preliminary success in a clinical PTSD sample. Studies of attention bias modification provided more mixed results. This heterogeneous picture may be explained by differences in the type of population or variations in the CBM procedure. Therefore, we sketched a detailed research agenda targeting the challenges for CBM in posttraumatic stress.